Incidental Findings on Brain Imaging in the General Pediatric Population

Jansen, Philip R.; Dremmen, Marjolein H G; Berg, Aaike Van Den; Dekkers, Ilona A.; Blanken, Laura M. E.; Muetzel, Ryan L.; Bolhuis, Koen; Mulder, Rosa M.; Kocevska, Desana; Jansen, Toyah A; Wit, Marie Claire Y. de; Neuteboom, Rinze F.; Polderman, Tinca J. C.; Posthuma, Daniëlle; Jaddoe, Vincent W. V.; Verhulst, Frank C.; Lugt, Aad van der; White, Tonya

doi:10.1056/nejmc1710724

Cited by 94 publications

(77 citation statements)

References 5 publications

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“…In the future, when proceeding to the MR imaging of older children within the FinnBrain Birth cohort study, the correct handling of the incidental findings will be even more important, as incidental findings may include potential malignancies, etc. (37).…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Risk Factors of Incidental Findings in Brain MRIs of Healthy Neonates—The FinnBrain Birth Cohort Study

et al. 2020

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Background: Birth is a traumatic event with molding forces directed to the fetal skull, which may result in intracranial hemorrhages. However, the knowledge on prevalence and risk factors of incidental brain magnetic resonance imaging (MRI) findings in infants is still inconclusive. Methods: The prevalence and nature of incidental MRI findings were assessed in a birth cohort of 175 asymptomatic infants. The role of delivery method as well as other potential risk factors for intracranial hemorrhages were evaluated. The infants underwent 3T MRI at the age of 2-5 weeks, and the neurological status of the infants with an incidental finding was evaluated by a pediatric neurologist. Information on the delivery method, duration of delivery, parity, used anesthesia, oxytocin induction, and Apgar score was gathered to evaluate their association with the prevalence of hemorrhages. Results: Incidental intracranial hemorrhages were detected in 12 infants (6.9%), all following spontaneous or assisted vaginal delivery. Vacuum-assistance was found to be a risk factor for subdural hemorrhages with an odds ratio (OR) of 4.7 (95% CI [1.18; 18.9], p = 0.032). All infants were evaluated to develop normally by their clinical status. Conclusions: Incidental intracranial hemorrhages are relatively common among infants born by vaginal delivery. They are often of little clinical significance within the first years of life and have unlikely consequences for later neurodevelopment either. Despite their benign character, investigators should be prepared to share this information with parents competently as the findings can cause parental anxiety, and especially as the popularity of MRI as a research tool is increasing.

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Section: Discussionmentioning

confidence: 99%

Prevalence and Risk Factors of Incidental Findings in Brain MRIs of Healthy Neonates—The FinnBrain Birth Cohort Study

et al. 2020

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“…While visual inspection of images remains crucial, especially for the identification of incidental findings (Jansen et al, ), automated measures can provide important quantitative information. In fact, comparing an automated versus visual ratings with images that were manipulated, Gardner et al () found that visual raters were unable to detect slice thickness increases of 40%, whereas the automated approach was able to quantify even minor changes.…”

Section: Discussionmentioning

confidence: 99%

“…At the time of the MRI acquisition, T 1 images were evaluated for incidental findings and rated for image quality using a six-point Likert scale (Jansen, van der Lugt, & White, 2017). The quality assessment levels for the scans were: unusable, poor, fair, good, very good, and excellent.…”

Section: Generation R Studymentioning

confidence: 99%

Automated quality assessment of structural magnetic resonance images in children: Comparison with visual inspection and surface‐based reconstruction

White

Jansen

Muetzel

et al. 2017

Human Brain Mapping

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Motion-related artifacts are one of the major challenges associated with pediatric neuroimaging. Recent studies have shown a relationship between visual quality ratings of T images and cortical reconstruction measures. Automated algorithms offer more precision in quantifying movement-related artifacts compared to visual inspection. Thus, the goal of this study was to test three different automated quality assessment algorithms for structural MRI scans. The three algorithms included a Fourier-, integral-, and a gradient-based approach which were run on raw T -weighted imaging data collected from four different scanners. The four cohorts included a total of 6,662 MRI scans from two waves of the Generation R Study, the NIH NHGRI Study, and the GUSTO Study. Using receiver operating characteristics with visually inspected quality ratings of the T images, the area under the curve (AUC) for the gradient algorithm, which performed better than either the integral or Fourier approaches, was 0.95, 0.88, and 0.82 for the Generation R, NHGRI, and GUSTO studies, respectively. For scans of poor initial quality, repeating the scan often resulted in a better quality second image. Finally, we found that even minor differences in automated quality measurements were associated with FreeSurfer derived measures of cortical thickness and surface area, even in scans that were rated as good quality. Our findings suggest that the inclusion of automated quality assessment measures can augment visual inspection and may find use as a covariate in analyses or to identify thresholds to exclude poor quality data.

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“…7,60 This is found in up to 0.9% of the general adult population and 0.6% of the general pediatric population. 28,65 One can further categorize patients with radiological tonsillar ectopia by anatomical findings at the foramen magnum, namely the presence or absence of "peg-like" or "pointed" tonsils and effacement of CSF spaces. 60 Lesions with these findings are more likely to be associated with symptomatic patients.…”

Section: Definition Of Cimmentioning

confidence: 99%

The Chiari I malformation

McClugage¹,

Oakes²

2019

Journal of Neurosurgery: Pediatrics

100

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As with many pathologies, the course of our understanding of the Chiari I malformation (CIM) has developed extensively over time. The early descriptions of the Chiari malformations by Hans Chiari in 1891 opened the door for future classification and research on this topic. However, even over a long timeframe, our understanding of the pathophysiology and, more importantly, treatment, remained in its infancy. As recently as the 1970s, CIM was not discussed in popular neurology textbooks. Syringomyelia is listed as a degenerative disorder with no satisfactory treatment. Radiation therapy was considered an option in treatment, and surgery was thought to play no role. During the last 40 years, equivalent to the duration of a neurosurgical career, our understanding of the pathophysiology and natural history of CIM, coupled with modern MRI, has improved the treatment paradigm for this patient population. More importantly, it has given us evidence confirming that CIM is a disorder responsive to surgical intervention, giving patients once thought to be destined for lifelong disability a comparatively normal life after treatment. The purpose of this article is to offer a review of CIM and its important associated entities. The authors will discuss the evolution in understanding of the Chiari malformation and, importantly, distinguish between symptomatic CIM and asymptomatic tonsillar ectopia, based on imaging and presenting symptomatology. They will discuss techniques for surgical intervention, expected outcomes, and complications after surgery. Proper patient selection for surgery based on appropriate symptomatology is tantamount to achieving good surgical outcomes in this population, separating those who can be helped by surgery from those who are unlikely to improve. While our knowledge of the Chiari malformations continues to improve through the efforts of clinical and basic science researchers, surgeons, and patients, our current understanding of these entities represents a monumental improvement in patient care over a relatively short time period.

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Incidental Findings on Brain Imaging in the General Pediatric Population

Cited by 94 publications

References 5 publications

Prevalence and Risk Factors of Incidental Findings in Brain MRIs of Healthy Neonates—The FinnBrain Birth Cohort Study

Prevalence and Risk Factors of Incidental Findings in Brain MRIs of Healthy Neonates—The FinnBrain Birth Cohort Study

Automated quality assessment of structural magnetic resonance images in children: Comparison with visual inspection and surface‐based reconstruction

The Chiari I malformation

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